CBHS recognises the value of complaints as an important tool in monitoring and responding to customer expectation. This type of feedback is used to improve the level of our service and products.
Purpose
This policy sets out the process and management of complaints from inception to satisfaction or final determination, irrespective of the nature of the complaint. The processes within this policy apply to all complaints received from members, providers and organisations.
- To increase member satisfaction with CBHS and enhance our relationship with members.
- Recognise, promote and protect complainants' rights, including the right to comment and complain.
- Provide an efficient, fair and accessible mechanism for resolving member's complaints.
- Monitor complaints in an endeavour to improve the quality of products, services and communications.
- Provide information to consumers on the complaints handling process for the services and products of the organisation.
Definitions
A complaint is an expression of displeasure, grievance or resentment, written or verbal, as a result of poor service, benefits, product or processes.
- Complainant - person or organisation making a complaint.
- Member - a person who being entitled to membership of CBHS, has joined CBHS.
- Dispute - a pursued unsatisfied complaint.
- Organisation - a company, firm, enterprise, or association, or part thereof, whether incorporated or not, public or private, that has its own function(s) and administration.
- Provider - an organisation or sole trader providing a product or a service to a member.
- Quality - the totality of features and characteristic of a product or service that bears on its ability to satisfy stated or implied needs.
- Systemic problem - is caused by failures in the product or service design, delivery systems or organisation policies or procedures.
Commitment
CBHS is committed to the effective implementation of the complaints handling policy and a fair and reasonable outcome.
Fairness
CBHS will listen to all complainants as they have a right to be heard, consider documentation provided by the complainant, inform the complainant of the complaints handling process, be fully informed of any decisions and outcomes and treated confidentially if requested.
Resources
CBHS will have appropriately selected, adequately trained and well supported staff to handle complaints.
Accessibility
Complaints may be made in the following ways:
- Telephone via our Member Care Centre on 1300 654 123.
- Facsimile on 02 9843 7676.
- Email to
- Mail to CBHS Health Fund Limited, Locked Bag 5014, Parramatta, NSW 2124
- In person at 10 Pitt Street, Parramatta, NSW 2150
Responsiveness
Complaints shall be logged on receipt, responded to within two working days in writing by staff (Level 1). CBHS will make every attempt to resolve the matter immediately.
Escalation of Complaints
If the complaint has not been resolved it will be referred to the relevant Manager (Level 2) who will address the complaint within three working days.
If the complainant is not satisfied with the decision, the complaint may be referred to the CBHS' Disputes Resolution Committee (Level 3).
If the complainant disagrees with the Committee's decision, they may be referred to the Private Health Insurance Ombudsman (PHIO). Contact details of the PHIO are:
Level 22, 580 George Street
Sydney NSW 2000
Complaints Hotline: 1800 640 695
Telephone: (02) 8235 8777
Facsimile: (02) 8235 8778
Office hours are 9am to 5pm, Sydney Time, Monday to Fridays (excludes public holidays).
Consumers who are deaf, hearing or speech impaired should contact them through the National Relay Service (Tel: 13 25 44).
Consumers unable to speak English should contact them through the Translating and Interpreting Service (Tel: 13 14 50).
Email:
Website: www.phio.org.au
Charges
CBHS does not charge a fee for dealing with complaints.
Remedies
Responding to a complaint will, where possible, include a remedy appropriate to the situation. Remedies include:
- Refunds
- Information
- Referral
- Financial Assistance
- Apology
- Other
All aspects of complaints will be addressed and where appropriate, CBHS will consider offering the same remedy to others who may have had a similar experience but not lodged a formal complaint.
Data Collection
CBHS has a system in place for recording and monitoring complaints. All complaints are analysed to identify areas for improvement. Repetitive, recurring and systemic complaints that are identified or highlighted are used to review process and procedures.